In this blog, we shall discuss 2 questions.
Question 1.
How does one differentiate between posterior polar cataract (PPC) from central posterior subcapsular cataract (PSCC) ?
PPCs are different from PSCCs in following ways.
The PPCs are typically punched out well demarcated in the central posterior capsule. Posterior polars have concentric rings (onion whorl patterned) around the central opacity (bull’s eye) with translucent & fibrotic areas. With experience one is able to make out the difference. Rarely the two entities are difficult to differentiate. In such difficult situations see the other eye as well. A PSCC in the other eye usually makes the diagnostic decision better. If the patient is pseudophakic see the integrity of posterior capsule. A posterior capsular defect in the other operated eye should beware you about the predisposition to posterior capsular rent. When in doubt, consider & manage as PPC.
Question 2.
With the advent of smaller Rhexis, aiming to cover IOL edge all round, is there any relevance of removing anterior capsular cells while doing I/A? Is it not better to leave them behind?
The concept of Capsulorhexis covering the IOL optic is a long proven practice . The aim is to size the rhexis so that it is 0.5 to 1.0 mm smaller than the optic diameter. Removing the Lens epithelial cells under the anterior capsule was stopped by many of us as it did not have much effect on PCO. The IOL square edge shape became the focus of attention. However, with the advent of premium IOLs the importance of Effective Lens Position (ELP) has become very important. For consistent ELP the IOL should remain at its assumed plane. A small shift of 0.5 mm can change the refractive status by 1.0 D. A 4.0 mm rhexis gives a long post operative ELP. Anterior capsular polishing reduces anterior capsular opacification & capsular phimosis. Capsular phimosis can change ELP. Hence the need for anterior capsular polishing arises. The incidence of capsular phimosis is the least with Acrylic IOLs. There are certain cases which are more prone to capsular phimosis like Pseudoexfoliation ,patients of RP, advanced age, high myopes & patients of uveitis.Anterior capsular polishing can be planned accordingly.
Loved the drive on this Nissan Frontier Truck from Orange County to Bay Area, San Francisco
Took my folks to Google street, Mountain view, CA.